RAE-Corp

Application for Employment

In compliance with Federal and State equal employment opportunity laws, qualified applicants are considered for all positions without regard to race, color, religion, sex, national origin, age, marital status, veteran status, all disabilities, or any other protected group status.

Position Applied For: Date of Application:
How did you learn about us?


APPLICANT INFORMATION
Last Name: First Name: Middle Name:
Social Security Number: Email Address:
Street Address:
City: State: ZIP Code: Phone Number:
Are you at least 18 years old? Are you available to work:
Are you authorized to work in the US? Can you travel if job requires?
Date Available to Work: Desired Salary range:
Have you ever been convicted or plead guilty or "no contest" to any crime?
(AN AFFIRMATIVE ANSWER TO THIS QUESTION WILL NOT NECESSARILY DISQUALIFY YOU FROM CONSIDERATION)
If yes, please explain the details and dates:


EMPLOYMENT

Have you ever worked for this company?
If so, when?

Are you currently employed?
If not, when was your last day of employment?


EMPLOYMENT HISTORY    Please list in order from most recent.
EMPLOYER 1
Company: Type of Business:
Address: Phone:
Job Title: Supervisor Name:
Dates of Employment
From:

To:
Responsibilities:
Reason for leaving:
May we contact your previous
supervisor for a reference?
Starting Salary: Ending Salary:
EMPLOYER 2
Company: Type of Business:
Address: Phone:
Job Title: Supervisor Name:
Date of Employment
From:

To:
Responsibilities:
Reason for leaving:
May we contact your previous
supervisor for a reference?
Starting Salary: Ending Salary:
EMPLOYER 3
Company: Type of Business:
Address: Phone:
Job Title: Supervisor Name:
Date of Employment
From:

To:
Responsibilities:
Reason for leaving:
May we contact your previous
supervisor for a reference?
Starting Salary: Ending Salary:


EDUCATIONAL BACKGROUND
Type of School Name and City Degree Earned Course or Major
High School / GED
College / Undergraduate
College / Post Graduate
Technical School
Other
SKILLS AND EXPERIENCE
Please list any special qualifications, training, education, skills, or experience that you feel warrant consideration.
Please list any business or manufacturing equipment operating abilities or certifications you have which might be useful on the job for which you are applying.


NOTE TO APPLICANT: DO NOT ANSWER THIS QUESTION UNLESS YOU HAVE BEEN INFORMED ABOUT THE REQUIREMENTS OF THE JOB FOR WHICH YOU ARE APPLYING
Are you capable of performing, with or without a reasonable accommodation, the activities involved in the job or occupation for which you have applied? A review of the activities involved in such a job or occupation has been given.
  


REFERENCES    Please list three professional references.
REFERENCE 1
Full Name: Relationship:
Company: Phone:
Address:
REFERENCE 2
Full Name: Relationship:
Company: Phone:
Address:
REFERENCE 3
Full Name: Relationship:
Company: Phone:
Address:


DISCLAIMER AND SIGNATURE
Authorization
I certify that I have read and understand all parts of this application and certify that I have truthfully and completely answered all questions. I understand that falsification of any of the information given herein or on any other employment form or failure to accurately and completely respond and disclose information sought by this application or employment forms is grounds for immediate termination, regardless of when such falsifications may be discovered.

I authorize RAE Corporation and its representatives to investigate my education, employment experience, criminal conviction records, and all other aspects of my background relevant to my proposed employment, including all statements made by me in my application for employment. I release RAE Corporation and its representatives, as well as any person to whom such inquiry is directed, from any liability arising directly or indirectly from any such investigations.

Further, I understand that any offer of employment, as well as continued employment, will be contingent upon successfully passing a pre-employment drug-screening test. I understand my employment with RAE Corporation is for no definite length of time. I understand my employment may be terminated at any time with or without cause, at the option of either RAE Corporation or myself. I understand that no employee or representative of RAE Corporation has any authority to make any agreement which is contrary to the foregoing. If accepted for employment, I agree to comply with all company policies and procedures and with all rules and regulations made known at the time of employment or any other time thereafter, and to perform all duties assigned to me to the best of my ability.
Do you understand the policies and agree to abide by the requirements as listed above?
Signature: Date:


RAE Corporation is an Equal Opportunity Employer
EEO/AA M/F/V/D